Horizon Scanning in South Africa: Health and HIV and AIDS

by DANIELS, D.M., 2007
Research report, Human Sciences Research Council report. Prepared for DFID.

South Africa has a mature HIV and AIDS epidemic, with 11% of the population having been infected. A review of possible scenarios provides insight into the outlook towards 2030. The Live the Future scenarios discussed here were based on two sets of branching points – who has the power, and what their goals are. Summer is the best-case scenario and involves government spearheading a strong, integrated and collaborative response to HIV and AIDS by focusing on prevention and on development needs. In this case, adult prevalence could drop from 18% in Winter to 7%. An estimated 5.9 million new infections could be averted between 2005 and 2025, as could some 2.5 million AIDS-related deaths. Public health sector costs are, however, highest in Summer, as money is spent on the overall improvement of the public health system so that everyone benefits in the long run. The driving forces that could shape South Africa’s future include matters of governance and values; poverty, inequality, unemployment and mobility; the availability of government resources; and behavioural change among individuals. Key policy implications that arise from these driving forces include the need to prioritise prevention strategies. Choices need to be made around crisis management versus long-term planning, and whether the focus will be on HIV specifically or on broader development issues. Innovative ways to address the growing number of orphans could prevent an even bigger crisis. Policymakers also have to consider funding priorities and the level of collaboration needed to make a meaningful difference.